| Doctor Name: | ERIC ELLIOTT |
| NPI Number: | 1265503130 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSN-APRN |
| License Number: | 2001021688 |
| Business Practice Address: | 2400 Boonslick Dr Boonville, MO - 652331935 |
| Business Phone Number: | 6608829840 |
| Business Fax Number: | 6608823504 |
| Mailing Address: | Po Box 5111, SPRINGFIELD |
| State: | MO |
| Postal Code: | 658015111 |
| Phone Number: | 6608829840 |
| Fax Number: | 6608823504 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2001021688 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |